HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Our commitment to your privacy

Ahava Mental Health Counseling is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your information

Treatment. To provide, coordinate, or manage your care, including consultation with other providers when you authorize it.
Payment. To bill and obtain payment for services, including providing superbills you may submit to your insurer for out-of-network reimbursement.
Health care operations. For necessary administrative and quality-related activities of the practice.
As required by law. Including limited circumstances related to safety, such as a serious threat of harm, or suspected abuse, as required or permitted by law.

Other uses and disclosures will be made only with your written authorization, which you may revoke at any time in writing.

Your rights regarding your health information

To request access to and a copy of your records.
To request a correction of your records.
To request restrictions on certain uses and disclosures.
To request confidential communications by alternative means or at an alternative location.
To receive an accounting of certain disclosures.
To receive a paper copy of this notice on request.

Questions or complaints

If you have questions about this notice or believe your privacy rights have been violated, contact us at Dina@ahavamentalhealth.com or (908) 955-3990. You may also file a complaint with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

This is a general template provided for design purposes. It must be reviewed and finalized by the practice (and ideally a healthcare attorney or compliance professional) to ensure it accurately reflects the practice’s policies and meets all legal requirements before use.